| Abstract [eng] |
Depression affects approximately 4 % of the global population and is diagnosed about 1.5 times more often in women than in men. The risk of depressive disorders in women may increase during certain stages of reproductive life, one of which is perimenopause. During this period, depression may present with distinct clinical features that often overlap with menopausal symptoms; therefore, its diagnosis remains an important clinical issue. Treatment-related aspects are no less important, as their evaluation in the literature remains heterogenous. Aim: To review and summarize scientific literature data on the clinical presentation, diagnosis, and treatment of depression during the perimenopausal period. Objectives: 1. To assess the risk of depression during perimenopause and identify the main factors associated with its occurrence. 2. To review the clinical features of depression during perimenopause and evaluate their overlap with menopause-related symptoms occurring during this period. 3. To discuss the diagnostic features of depression during perimenopause, the difficulties in differentiating it from perimenopause-related complaints, and the assessment instruments used in the literature. 4. To evaluate treatment options for depression during perimenopause by discussing the main pharmacological and non-pharmacological treatment methods. Methods: A scientific literature search was conducted in the PubMed database and the Google Scholar search engine. The following keywords and their combinations were used: perimenopause, menopausal transition, menopause transition, depression, depressive disorder, depressive symptoms, epidemiology, risk, symptoms, screening, diagnosis, hormone replacement therapy, treatment, management. A total of 120 publications were included in the literature review. Results: Perimenopause is associated with an increased risk of depressive symptomatology. During this stage of reproductive life, the occurrence of depression is influenced by a combination of various demographic, socioeconomic, psychosocial, health-related, and biological risk factors, as well as their interactions. The clinical presentation of depression occurring during perimenopause includes not only the typical features of depression but also other symptoms, such as irritability or hostility, paranoid thoughts, and memory or concentration difficulties. During perimenopause, women may also experience menopause-related symptoms, such as hot flashes, sleep disturbances, headache, fatigue, joint stiffness or pain, which may complicate differential diagnosis. The literature still lacks clear diagnostic criteria specifically adapted to this period, while studies use various standard scales assessing depressive symptoms. Data on treatment methods for depression during perimenopause and their effectiveness remain inconsistent. Although menopausal hormone therapy has not yet been approved as a treatment for depression, many studies have observed its beneficial effects on both depressive symptoms and perimenopausal somatic symptoms. Among antidepressants, the largest amount of literature data is available on escitalopram, venlafaxine, duloxetine, and desvenlafaxine; however, the evidence base remains limited due to the small number of studies and small sample sizes. Conclusions: Depression during perimenopause is an insufficiently studied condition characterized by specific clinical and diagnostic features that complicate its recognition. Due to the heterogeneous assessment instruments used across studies and inconsistent data on treatment, an individualized clinical approach is necessary. |
